a mental health and wellness blog

One Thing You Need to Know About Bipolar Disorder

DISCLAIMER: Please do not EVER adjust your medication without first talking to a mental health care professional. I’m not a professional, and this isn’t intended to be medical advice. Please, please, PLEASE talk to your psychiatrist before making any changes.

I went to see a new psychiatrist last week. I’ve struggled to find one that’s a good fit, and I think I’ve finally found the right person. If you’re someone who’s shared that struggle, you know what a big deal that is. My appointment was an hour and a half long, and I’ve never met with someone who was so thorough. As is always the case in a first session with a new psychiatrist, I struggled and dug in the deep recesses of my brain, trying to remember nine years’ worth of trial and error with psychiatric medications.

I laid everything out for her as she just nodded, took notes, and occasionally asked follow-up questions. At one point, she asked a question that I had never thought very hard about.

“Have you ever been on an antidepressant that helped for more than a couple months?”“Um, no?”

That’s just the way antidepressants work, right? After a while, they stop working and you have to up your dosage or switch medications, right? …Right?

She didn’t comment on my answer, she just added it to her notes. Finally, after over an hour of this, she sat back from her desk and looked at me.

“Well, no wonder you feel awful. You should never have been on antidepressants.”

Uh. What?

It turns out that there is a sizable chunk of evidence that antidepressantsshouldn’t be used to treat bipolar disorder. There’s all kinds of infoout there that suggests that antidepressants can increase manic episodes, which is pretty scary. The real kicker for me though, it that antidepressants can actually lead to or worsen rapid cycling, which in a nutshell means that while it may shorten the depressive episodes, you’re more likely to relapse sooner and more frequently.

This isn’t even new information. All it took was a quick Google search to come up with a whole handful of articles on why antidepressants shouldn’t be used to treat bipolar. While we (obviously) shouldn’t rely on Google to make our medical choices for us, the fact is that the information is out there. So why the hell have I been on antidepressants for the past 9 years to treat my bipolar disorder?

What does this mean for you? Well, it depends on your diagnosis and history. If you’re someone who’s diagnosed bipolar, you’re on an antidepressant that’s been working for you for a long time (like, over a year), and you aren’t experiencing rapid cycling, you’re probably okay. If you’re taking antidepressants and you’ve noticed any of the following (whether you’re officially diagnosed bipolar or not), it probably wouldn’t hurt to have a conversation with your psychiatrist:

Rapid cycling (more than four mood episodes in a year)

Irritability/agitation

Severe insomnia

Increased manic episodes

Antidepressants only seem to improve your mood for a short time before getting worse again

We all know that I’m not opposed to medication. This post isn’t meant to scare people with bipolar disorder into going off their meds. For the love of God, DON’T DO THAT. Every person is different, and the right care plan for you might look completely different than the right care plan for me, even if we have the exact same diagnosis. If you’re someone who’s been put on antidepressants, it’s entirely possible that your psychiatrist knows about the risks and has decided for one reason or another that antidepressants are the right fit for you.

Don’t call your psychiatrist up and scream at them for being an irresponsible charlatan and screwing up your care (even if you want to). Just pay attention to yourself, your mood, and your medications and share the information with your psychiatrist. It never hurts to ask more questions and get more answers.

Part of me wants to be so angry with every psychiatrist who has put me on antidepressants (and there are a lot of them), but I’m trying really hard to focus on the positive: I’m finally in competent hands and getting the care I need. We’re (slowly) weaning off the antidepressant I’ve been on since I was released from the hospital and adding a mood stabilizer. I’ll let you know how it goes.